Abstract
Simple SummaryHepatocellular carcinoma (HCC) is the fifth most common cancer in men worldwide and the second leading cause of cancer death. Liver transplantation (LT) is one of the treatment options for patients with HCC. Recently, there have been many reports of the usefulness of locoregional therapy, such as transarterial chemoembolization and radiofrequency ablation, for HCC as pretreatment before LT. In Western countries, locoregional therapy is used to bridge until transplantation to prevent drop-outs from the waiting list or for downstaging to treat patients with advanced HCC who initially exceed the criteria for LT. With the progress of locoregional therapy, new reports on the effects of bridging and downstaging locoregional therapy as pretransplant treatment are increasing in number.Recently, there have been many reports of the usefulness of locoregional therapy such as transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma (HCC) as pretreatment before liver transplantation (LT). Locoregional therapy is performed with curative intent in Japan, where living donor LT constitutes the majority of LT due to the critical shortage of deceased donors. However, in Western countries, where deceased donor LT is the main procedure, LT is indicated for early-stage HCC regardless of liver functional reserve, and locoregional therapy is used for bridging until transplantation to prevent drop-outs from the waiting list or for downstaging to treat patients with advanced HCC who initially exceed the criteria for LT. There are many reports of the effect of bridging and downstaging locoregional therapy before LT, and its indications and efficacy are becoming clear. Responses to locoregional therapy, such as changes in tumor markers, the avidity of FDG-PET, etc., are considered useful for successful bridging and downstaging. In this review, the effects of bridging and downstaging locoregional therapy as a pretransplant treatment on the results of transplantation are clarified, focusing on recent reports.
Highlights
As of 2018, hepatocellular carcinoma (HCC) is the fifth most common cancer in men worldwide and the second leading cause of cancer death [1]
This review focuses on the recent literature and clarifies the role of locoregional therapy before Liver transplantation (LT)
Toso et al [72] from Switzerland reported that, the recurrence rate was slightly higher in the downstaging group, there was no difference in survival between the downstaging group and the control group when the tumor burden was limited to Total tumor volume (TTV) ≤115 cm3 and AFP ≤400 ng/mL
Summary
As of 2018, hepatocellular carcinoma (HCC) is the fifth most common cancer in men worldwide and the second leading cause of cancer death [1]. In 1993, Bismuth et al [5] reported a 3-year recurrence-free survival rate of 83% after LT in cases with 1–2 lesions ≤3 cm, which was significantly better than that of 44% in cases with ≥3 lesions ≥3 cm and that of 18% after hepatectomy They showed that tumor size and number affected transplant outcomes, as well as the superiority of LT over hepatectomy. Using this allocation system, even in the USA, where the number of deceased donors is overwhelmingly larger than in Japan, it has been reported that 12% of HCC patients on the waiting list drop-out due to HCC progression in 6 months and 15–30% in a year, and the waiting period is often prolonged more than one year [11,12]. In addition to preventing drop-out from the waiting list mentioned above, BT has the potential to shrink tumors and improve the results of LT and exclude biologically aggressive HCC
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